“The Securities and Exchange Commission has charged that six expert network consultants and employees illegally tipped hedge funds and other investors to generate nearly $6 million in illicit gains… The SEC alleged that four technology company employees, while moonlighting as consultants or ‘experts’ to Primary Global Research LLC (’PGR’) without the knowledge of their employers, abused their access to inside information about such technology companies as AMD, Apple, Dell, Flextronics, and Marvell. The consultants received hundreds of thousands of dollars in purported consulting fees from PGR for sharing the inside information with PGR employees and clients, according to the SEC.”
“Clark said people have come up with clever ways to file fraud claims by staging accidents where everyone in the accident is part of it and they try to get some sort of disability payment.”
“Topping the list are Miami brothers Carlos, Luis and Jose Benitez. Owners of a string of medical clinics, they allegedly scammed Medicare out of $119 million by billing for costly HIV drugs that patients never received or did not need. Authorities say they bought hotels, helicopters and boats before fleeing to Cuba.”
“Companies worldwide have seen an increase in fraud due to ineffective internal controls, according to a report issued by Deloitte yesterday… a significant percentage of companies (51%) recognised they did not have sufficient numbers of trained staff to provide effective assurance on fraud risk in their organisations, with smaller businesses finding themselves even more constrained.”
“The buyer redeemed the ticket later at the outlet in Burlington and wasn’t told that he won a free ticket, investigators determined, according to the CBC. That ticket went on to win a $12.5 million jackpot. It was claimed by Kathleen Chung, sister and daughter of men who worked at the outlet.”
“The current hype around ‘big data‘ has caused some analysts and vendors to declare the death of data warehousing, and in some cases, the demise even of the relational database. A prerequisite to discussing these claims is to understand and clearly define the term ‘big data.’ However, it’s a fairly nebulous concept.”
“In addition, the Medicare Fraud Strike Force has been extended to seven cities. Using advanced data analysis techniques to identify high billing levels in healthcare fraud hot spots, the interagency teams can target emerging or migrating schemes along with chronic fraud by criminals masquerading as healthcare providers or suppliers.”
“Florida CFO Jeff Atwater announced the arrest of David Rodriguez-Socarras, who officials allege used a ’shell’ company and fictitious name in order to cash nearly $3 million in payroll checks through a money service business to avoid workers’ compensation premiums and payroll taxes.”
“By 2013 the amount of traffic flowing over the internet annually will reach 667 exabytes, according to Cisco, a maker of communications gear. And the quantity of data continues to grow faster than the ability of the network to carry it all.”
“The federal government pointed to the expansion of Medicare Fraud Strike Force teams as one reason for the increased recovery. In FY 2010, the total number of cities with strike force prosecution teams was increased to seven, all of which have teams of investigators and prosecutors dedicated to fighting fraud. The strike force teams use advanced data analysis techniques to identify high-billing levels in health care fraud hot spots so that interagency teams can target emerging or migrating schemes along with chronic fraud by criminals masquerading as health care providers or suppliers.”
“MDM is the latest attempt to solve the old problem of inconsistent versions of important data at the centre of an organization,” said Andrew White, research vice president at Gartner. “As with any new initiative, there is a lot of hype and confusion, and with hype and confusion comes misunderstanding. Executive sponsors of MDM and MDM program managers must avoid several common mistakes that have been known to derail MDM initiatives in the past.”
“The report notes that by 2020, much of this data will be held in cloud environments or will be “touched by cloud,” which means data that transits through a cloud service or is temporarily held in a cloud application. The report estimates that perhaps 15% of all data will be held in the cloud, and that around one-third will live in or pass through the cloud.”
“A contentious battle is heating up once again between State Farm Insurance Co. and a group of doctors that the insurer alleges have been involved in a multimillion-dollar insurance fraud scheme, according to a lawsuit. The suit claims the doctors submitted fraudulent claims based on ‘medically unnecessary diagnostic procedures’ used on those in car accidents.”
“A Booz & Company study recently quantified some of the projected benefits from a proposed e-health initiative in Australia: by 2020, the programme could eliminate up to 10,000 deaths caused by medication mistakes, along with up to 310,000 unnecessary hospital admissions, 2 million unnecessary outpatient visits, and 7 million laboratory tests.”
“In 2009, midsize businesses (53%) were mainly consumed with reducing costs and increasing efficiencies. The progress and momentum gained from these efforts continue to yield critical benefits and advantages for midsize businesses. Because of this momentum, they are now in a position to turn their attention to more forward-looking aspects of their business. This is demonstrated by the significant increase in focus on customers (+20 pts), innovation (+7 pts), and revenue growth (+5 pts).”
“Strategic decisions about cloud computing should both draw upon and inform the EA. An organization must have a mature and well formed understanding of its architecture components (e.g., business processes, services, applications and data) to make meaningful decisions related to cloud computing, such as whether a move to the cloud is advantageous, what services most lend themselves to a cloud deployment, and what cloud deployment model (e.g., private, public) makes the most sense. There are three key roles for EA in facilitating cloud computing strategy and planning…”
“‘Medicaid cheaters rob taxpayers, hurt needy patients and push medical costs higher for all of us,’ Cooper said in a statement. ‘We’re stopping the waste and abuse and making violators pay.’ During the federal fiscal year that ended Sept. 30, the Medicaid Investigations Unit of the state Attorney General’s Office won 22 criminal convictions and negotiated 18 civil settlements worth $53.5 million.”
“Under Secure Flight, the Transportation Security Administration (TSA) prescreens passenger name, date of birth and gender against terrorist watchlists before passengers receive their boarding passes. In addition to facilitating secure travel for all passengers, the program helps prevent the misidentification of passengers who have names similar to individuals on government watchlists. Prior to Secure Flight, airlines held responsibility for checking passengers against watchlists.”
“We talked a week ago about the rapidly emerging market space called Big Data. One statistic that opened my eyes is Gartner’s prediction that the volume of new data generated by enterprises will grow by 650% in the next five years, and 80% of that will be unstructured data! The 451Group’s definition of Big Data describes a growing need for non-traditional processes that can treat massive amounts of data as a whole, thereby making it impossible to use many traditional tools and techniques.”
“These tools will integrate many of the agency’s pilot programs into the National Fraud Prevention Program and complement the work of the joint HHS and Department of Justice Health Care Fraud Prevention and Enforcement Action Team (HEAT). ‘Preventing fraud is more effective than the old ‘pay and chase’ model of fighting fraud after a sham provider has been paid and disappeared,” CMS administrator Donald Berwick said in a statement. “By using new predictive modeling analytic tools we are better able to expand our efforts to save the millions — and possibly billions — of dollars wasted on waste, fraud, and abuse.’”
“Concerns that internal initiatives, and the CIO’s clout, will be gutted and most funds redirected to the cloud are overstated–for now. But we are at an inflection point: IT has money to spend, but it can’t be allocated using the same old budget process that’s kept us in a rut of dedicating a third or more of our resources to keeping the lights on. Business leaders have little patience for high-priced, long-term IT slogs. They’ve seen massive 18-month projects fail and experienced success with lightweight software-as-a-service offerings. CIOs must look at each expenditure and think, ‘Will this buy us flexibility and advance the business?’”
“Results from the National Ambulatory Medical Care Survey (NAMCS) show that between 2009 and 2010, the percentage of physicians reporting having an electronic medical record/electronic health record (EMR/EHR) system that meets the criteria of a basic system increased by 14% and a fully functional system increased by 46%.”
“In the global marketplace, businesses, suppliers and customers are creating and consuming vast amounts of information. Gartner predicts that enterprise data in all forms will grow 650 percent over the next five years. According to IDC, the world’s volume of data doubles every 18 months. This flood of data, often referred to as “information overload,” “data deluge” and “big data,” clearly creates a challenge for business leaders.”
“Early this year, Gartner suggested that a ‘data deluge’ has begun. In his recent Dataspora Blog post about ‘Big Data’ and what it means, author Michael Driscoll presents a unique and interesting perspective on the massive amounts of data being generated and stored. According to The 451 Group’s definition…”
“Gartner released a report in November entitled, ‘Top 10 Technology Trends Impacting Information Infrastructure, 2011.’ Two of the top ten trends were ‘Entity Resolution and Analysis’ and ‘Master Data Management.’”
“According to Taxpayers Against Fraud, a nonprofit group based in Washington, D.C., National Medical then launched a campaign to force Ven-A-Care out of business. But in fighting back, Ven-A-Care staff discovered National Medical was paying kickbacks to doctors who prescribed medicines and services that weren’t needed, then billing Medicare and Medicaid exorbitant sums far in excess of what the medicines and services cost. The Justice Department eventually got a $486 million settlement from National Medical — and Ven-A-Care received $40 million as its reward under the False Claims Act.”
“Russian financial institutions reported 120 trillion roubles (2.44 trillion pounds) of suspicious transactions to the anti-money laundering watchdog in the first nine months of 2010, the Kommersant daily reported on Monday.”
“The era of Big Data has only just begun. In the latest edition of Database Trends & Applications, I provided a series of predictions about the year ahead, with an emphasis on data management. Here are 10 of them…”
“The segment of the cloud Salesforce leads, SaaS (software as a service), has grown from a tiny sliver of the enterprise software market just a few years ago to 10 percent in 2009, according to Gartner, which predicts that slice will expand to 16 percent by 2014. Even more dramatic is the firm’s projection that 85 percent of all new software will be delivered as a service by 2010.”
“In 2005 the United Kingdom embarked on the largest investment ($18 billion) in health information technology in the world. Yet despite expectations that the system would increase efficiency and reduce medical errors, their efforts neither improved health nor saved money — in fact in some cases, they may have led to patient harm. Britain’s government-run medical system is obviously different from our complex public-private insurance system.”
“‘This is where Secure Flight, the government-run program that is now vetting passengers before they receive their boarding passes, comes in. It replaces a more ad hoc system run by the carriers. ‘Prior to Secure Flight, the airlines themselves were responsible for matching all of their passengers against the watch lists, so each airline had their own system for doing that,’ said Greg Soule, a spokesman for the Transportation Security Administration. ‘Secure Flight takes the passenger watch list matching process away from the airlines and puts it all in one program under TSA, so it is a more consistent process across the board.’”
Immediately after the Christmas bomber incident in 2009, we highlighted the positive role that broader deployment of (id)entity resolution software could play in preventing terrorist actions. That thought was seconded this week in a piece published by the Canadian Broadcasting Company (CBC) entitled “Better data analysis for a safer world”:
The technology to connect the dots from disparate data sources already exists, and has done for quite some time. It’s called “entity resolution,” and corporations have been using it for years to compile and ensure accuracy in consumer data. Entity resolution can help avoid many of the mistakes that led to the attempted Christmas bombing: it can overcome spelling errors in databases, alert the right people to a threat in real time, and correlate literally billions of records on an ongoing basis.
… some technologies rely on strategies that actually destroy the forensic integrity of the data. Not all identity resolution technologies are the same. Ours can be configured using a number of strategies to fit particular customer performance requirements, sensitivity to false positives or false negatives, and Similarity Search behaviors, including specialized name algorithms that catch misspellings, nicknames, and ordering variations.
The CBC article suggests how expanding the current uses of entity resolution software could bring added benefits:
If the agencies that held these disparate pieces of information were connected and running entity resolution software, red flags would be raised automatically, and those warnings quickly transmitted to the people who make decisions. The same level of intelligent technology and data analysis is important in business, where entity resolution originated.
That last statement supports our January post where we mentioned other uses for the technology:
Although the consequences are grimmer in homeland security situations, the challenges are the same for financial, healthcare, gaming, state and local government, and marketing applications.
The CBC article delineates how businesses benefit from entity resolution:
Knowing who your customers are, where they live, and what they are interested in gives your business a serious advantage - but for large organizations, that requires processing massive amounts of information. The potential for inaccuracies, duplication, and mistaken identity means that companies may be led into poor decisions by misrepresentative data. Entity resolution software was developed to mitigate these risks, and automatically format and clean up the available information.
CEO Mike Shultz has pointed out that our specific technology is “used more times every day for terrorist matching” than any other entity resolution software. Thankfully, the worlds of both business and government seem to be getting the message about the critical importance of this technology.
Infoglide Software provides entity resolution and analysis solutions for retail, banking, insurance, government, and law enforcement. Without the need for data cleansing or warehousing, Infoglide Software's Identity Resolution Engine™ (IRE) analyzes all of the information relating to individuals and/or entities from multiple sources of data and then applies...
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